Converting the DICOM Presentation State to AIM Version 3.0

Converting the DICOM Presentation State to AIM Version 3.0

Development Team(s) Development Technical Documentation Program Management Pattanasak Mongkolwat Pattanasak Mongkolwat Peter Yan Vladimir Kleper Carolyn Klinger (Editor) Contacts and Support Pattanasak Mongkolwat p-mongkolwat@northwestern.edu NA NA NA

1. Scope and Purpose...4 2. Overview...4 2.1. Technology Stack...4 2.2. Background Knowledge and Assumption...4 2.3. DICOM Presentation State...4 2.3.1. Presentation State Information Entity...4 2.3.2. Grayscale Softcopy Presentation State...5 2.3.3. Color Softcopy Presentation State...5 2.3.4. Pseudo-Color Softcopy Presentation State...5 2.3.5. Capturing GSPS, CSPS and PCSPS in the AIM Information Model...5 2.3.6. Missing Information from DICOM Presentation State...5 2.4. AIM Model...5 2.4.1. Overview...5 2.4.2. Types of AIM Instances...5 3. Converting DICOM Presentation State to AIM Instance...6 3.1.1. Converting GSPS to AIM 3.0...6 3.1.2. Converting CSPS to AIM 3.0...12 3.1.3. Converting PCSPS to AIM 3.0...12 4. Gap Analysis between DICOM Presentation State and AIM...13 4.1. Mapping Between DICOM Presentation State and AIM...13 4.1.1. AIM User...14 4.1.2. AIM Equipment...14 4.2. AIM Image Semantic Content...14

1. Scope and Purpose This document provides technical guidance on how to convert a Digital Imaging and Communications in Medicine (DICOM) Presentation State object [1] to an instance of Annotation and Image Markup (AIM) [2]. This document can be used by other developers to create a software tool to convert a DICOM presentation object to an AIM XML document or AIM DICOM SR object, using the provided AIM library [2]. 2. Overview AIM is used to express and capture image annotation and markup information relevant to images. An annotation can contain explanatory or descriptive information that is generated by humans or machines; this information directly relates to the content of a referenced image or images. An annotation describes the meaning of pixel information in images. Image markups include the graphical symbols or textual descriptions associated with an image. They can be used to show textual information and regions-of-interest (graphical drawing) that are next to, or more typically, overlaid upon, an image. Information from annotations and markups are used to populate an AIM instance via the AIM software library for the purpose of generating AIM DICOM SR objects and AIM native XML documents. A DICOM Presentation State captures image manipulations, such as window-level, pan, zoom, text and graphics placed on the image, flip and rotate, and applied to image. However, this information does not include semantic meaning provided by a human or machine (e.g. Computer Aided Detection). The AIM information model provides a mechanism to capture both graphical markups and explanatory information. In the real world, imaging vendors capture image manipulations in DICOM Presentation State objects. They may want to convert these DICOM objects to AIM XML documents or AIM DICOM SR objects. This document explains how imaging software developers can convert a DICOM Presentation State object to an AIM instance. 2.1. Technology Stack Technology Annotation and Image Markup Digital Imaging and Communications in Medicine Remarks A UML Information Model A Information Model for Medical Related Images Standard C++ Microsoft Visual Studio 2008 XMI Enterprise Architect 4.5 2.2. Background Knowledge and Assumption Readers are assumed to have a good knowledge about DICOM, particularly the DICOM Presentation State, and the AIM information model. Additional DICOM information can be found in the DICOM Standard Part 3, Softcopy Presentation State Information Object Definitions. Information about the AIM model can be found in the AIM Project Report [2]. 2.3. DICOM Presentation State 2.3.1. Presentation State Information Entity A DICOM Presentation State Information Entity provides a standard approach for a software developer to capture a device-independent grayscale space (P-Value) and color space (PCS-Value) along with graphical annotations. These graphical annotations contain spatial coordinates and grayscale contrast transformations that can be applied to the pixel data in the referenced image(s) for display purposes.

2.3.2. Grayscale Softcopy Presentation State The Grayscale Softcopy Presentation State (GSPS) includes grayscale space in P-values, grayscale contrast transformations of modality and VOI LUT [1], multi-frame images mask subtraction, section of an image to be displayed with zoom, rotation and/or flip, and graphical annotations, text and overlays. 2.3.3. Color Softcopy Presentation State Color Softcopy Presentation State (CSPS) can include color space in PCS-, color contrast transformations from device-dependent color to PCS-Value using ICC profile, section of an image to be displayed with zoom, rotation and/or flip, and graphical annotations, text and overlays. 2.3.4. Pseudo-Color Softcopy Presentation State Pseudo-Color Softcopy Presentation State (PCSPS) can include color space in PCS-, grayscale contrast transformations of modality and VOI LUT, a color palette to map the transformed grayscale values to pseudo-color, mask subtraction for multi-frame image, section of an image to be displayed with zoom, rotation and/or flip, and graphical annotations and text overlays. 2.3.5. Capturing GSPS, CSPS and PCSPS in the AIM Information Model AIM information model has a class called PresentationState that captures a SOP Instance UID of a referenced DICOM Presentation State object. The Presentation State object(s) have a collection of information stated in sections 2.3.2, 2.3.3 and 2.3.4 above. This information can be applied to the related image(s) referenced in the Presentation State object. 2.3.6. Missing Information from DICOM Presentation State The DICOM Presentation State does not have all of the information required by the AIM information model. Software developers shall provide missing information to the AIM information model. 2.4. AIM Model 2.4.1. Overview The AIM information model is described using an UML class diagram [3]. The model is used to express and capture image annotation and markup information relevant to images. Before you transform data from DICOM Presentation State to the AIM model, it is very important to fully understand the AIM model. The AIM 3.0 information model consists of 45 classes and 248 attributes. Most of AIM classes are optional. Three classes required for a valid AIM Image Annotation instance are ImageAnnotation, Person and ImageReference. 2.4.2. Types of AIM Instances An AIM instance can be of type ImageAnnotation or AnnotationOfAnnotation. Converting the DICOM Presentation State to an AIM instance can only be of type ImageAnnotation.

3. Converting DICOM Presentation State to AIM Instance This section explains how to map information from the DICOM Presentation State to the AIM information model. 3.1.1. Converting GSPS to AIM 3.0 Table 3.1.1-1 depicts information in DICOM GSPS that can be captured in the AIM model. GSPS Capabilities AIM Model Grayscale space in P-Value Grayscale contrast transformations of modality and VOI LUT Multi-frame images mask subtraction Section of an image to be display with zoon, rotation and/or flip Graphical annotations, text and overlays Captured graphical annotations and text Table 3.1.1-1. AIM Information Model and GSPS Capabilities Table 3.1.1-2 depicts AIM classes that can be mapped to Grayscale Softcopy Presentation State IOD Module, see DICOM part 3 (2009). In order to create a correct AIM instance, there are classes that must be created, namely ImageAnnotation, Person, DICOMImageReference, ImageStudy, ImageSeries, and Image. AIM Class Name DICOM GSPS IOD MODULES Circle DICOMImageReference but must be generated Ellipse Image Presentation State Relationship (C.11.11) ImageAnnotation but must be generated ImageSeries General Series (C.7.3.1) ImageStudy General Study (C.7.2.1) MultiPoint Person Patient (C.7.1.1) Point Polyline PresentationState SOP Common Module (C.12.1) TextAnnotation TwoDimensionSpatialCoordinate Table 3.1.1-2. AIM Information Model and GSPS Capabilities 3.1.1.1. AIM ImageAnnotation DICOM GSPS does not have information for the AIM ImageAnnotation class. This is required information for an AIM instance. Developers must provide the information in table 3.1.1.1-1. AIM ImageAnnotaiton Information Required Required Appropriate Integer value used to identify, name, or Yes 0 characterize the nature, properties, or contents of a thing. aimversion The version of the AIM model used by this annotation. Yes Library generates default comment Free text about the annotation not intended for No datetime rendering on the image. Date and Time (Julian) that the annotation was created. Yes Valid date & time

name uniqueidentifier codevalue codemeaning codingschemedesignator Human readable colloquial name of the annotation not guaranteed to be unique. A DICOM (style) unique identifier for this particular instance of an annotation. Used to reference a specific annotation. codevalue represents the identifier of the particular term in a coded vocabulary. Should be unique within a given coding scheme. The human understandable meaning of the coded value. The designator of the vocabulary from which the term was selected. codingschemeversion Identifies the version of the coding scheme No used. precedentreferencedannotationuid A Digital Imaging and Communication in Medicine (DICOM) (style) unique identifier for referencing earlier instance of AIM annotation. No Table 3.1.1.1-1. AIM ImageAnnotation and External Information Required Yes Yes Yes Yes Yes string New DICOM UID (ISO 8824) code sequence value Code sequence meaning Coding scheme designator DICOM UID 3.1.1.2. Converting GSPS Patient to AIM Person Table 3.1.1.2-1 depicts information in the DICOM GSPS Patient module (C.7.1.1, DICOM 2009) that can be captured in the AIM model. AIM Person Patient Module Attributes Required Appropriate Integer value used to identify, name, or characterize the Yes 0 nature, properties, or contents of a thing. name Patient s Name (0010,0010) Yes String id Patient ID (0010,0020) Yes String birthdate Patient s Birth Date (0010,0030) No Valid date sex Patient s Sex (0010,0040) No Valid value for DICOM tag (0010,0040) ethnicgroup Ethnic Group (0010,2160) No Valid value for DICOM tag (0010,0040) Table 3.1.1.2-1. AIM Person and GSPS Patient Module 3.1.1.3. AIM DICOMImageReference Table 3.1.1.3-1 depicts information in DICOM GSPS that can be captured in the AIM model. AIM Person Information Required Required Appropiate Integer value used to identify, name, or characterize the Yes 0 nature, properties, or contents of a thing. Table 3.1.1.3-1. AIM DICOMImageReference and External Information Required

3.1.1.4. Converting GSPS General Study to AIM ImageStudy Table 3.1.1.4-1 depicts information in DICOM GSPS General Study module (C.7.2.1, DICOM 2009) that can be captured in the AIM model. AIM ImageStudy General Study Module Attributes Required Appropriate Integer value used to identify, name, or characterize the Yes 0 nature, properties, or contents of a thing. instanceuid Study Instance UID (0020,000D) Yes startdate Study Date (0008,0020) Yes starttime Study Time (0008,0030) Yes Table 3.1.1.4-1. AIM ImageStudy and DICOM GSPS General Study Module 3.1.1.5. Converting GSPS General Series to AIM ImageSeries Table 3.1.1.5-1 depicts information in DICOM GSPS General Series module (C.7.3.1, DICOM 2009) that can be captured in the AIM model. AIM ImageSeries General Series Module Attributes Required Appriopriate Integer value used to identify, name, or characterize the Yes 0 nature, properties, or contents of a thing. instanceuid Series Instance UID (0020,000E) Yes Table 3.1.1.5-1. AIM ImageStudy and DICOM GSPS General Series Module 3.1.1.6. Converting GSPS Presentation State Relationship to AIM Image Table 3.1.1.6-1 depicts information in the DICOM GSPS Presentation State Relationship module (C.11.11, DICOM 2009) that can be captured in the AIM model. The developer examines the Reference Image Sequence (0008,1140) that may contain one or more Image SOP Instance Reference Macro Attributes (Table 10-3) and one SOP Instance Reference Macro Attributes (Table 10-11). AIM Image General Series Module Attributes Required Appropruiate Integer value used to identify, name, or characterize the Yes 0 nature, properties, or contents of a thing. sopiinstanceuid Referenced SOP Instance UID (0008,1155) Yes Table 3.1.1.6-1. AIM ImageStudy and DICOM GSPS Presentation State Relationship Module 3.1.1.7. Converting GSPS Graphical Annotation to AIM TextAnnotation, MultiPoint and TwoDimensionSpatialCoordinate DICOM GSPS Graphical Annotation module (C.10.5, DICOM 2009) may contain textual descriptions and graphical drawings. The information can be captured in the AIM model. This section explains how to extract textual information from GSPS Graphical Annotation module and store the information in AIM classes. First, textual information shall be extracted if the information exists in the Graphical Annotation module. It is stored in the TextAnnotation class. The coordinate is stored in two classes, MultiPoint and TwoDimensionSpatialCoordinate. The two classes indicate where the text value can be displayed. Table 3.1.1.7-1 captures the text value. The AIM model can have multiple instances of TextAnnotation. AIM TextAnnotation Graphic Annotation Module Attributes Required Appropriate Integer value used to identify, name, or characterize the Yes 0

nature, properties, or contents of a thing. font. Enter empty No fontcolor. Enter empty No fonteffect. Enter empty No fontsize. Enter empty No fontstyle. Enter empty No text Unformatted Text Value (0070,0006) Yes String textjustify Bounding Box Text Horizontal Justification (0070,0012) No if TLHC (0070,0010) is present. fontopacity. Enter empty No Table 3.1.1.7-1. AIM TextAnnotation Every instance of TextAnnotation must have an instance of Multipoint, which must also have an instance of TwoDimensionSpatialCoordinate. Table 3.1.1.7-2 only requires a unique integer value for shapeidentifier that applies to all TextAnnotation, MultiPoint, Point, Circle, Ellipse and Polyline instances within an AIM instance. AIM MultiPoint Graphic Annotation Module Attributes Required Appropriate Integer value used to identify, name, or characterize the Yes 0 nature, properties, or contents of a thing. linecolor. Enter empty No lineopacity. Enter empty No linestyle. Enter empty No linethickness. Enter empty No includeflag Value is always true. Yes True shapeidentifier A unique Integer number within a collection of text and Yes 0, 1, 2, etc. graphical markups Table 3.1.1.7-2. AIM MultiPoint The current TwoDimensionSpatialCoordinate does not have explicit support for the enumerated value of PIXEL or DISPLAY, as defined in DICOM standard, to indicate how a given coordinate shall be used. The x and y coordinates contain a value of type Double. If extracted values are between 0.0 and 1.0 for x and y, they are in the DISPLAY coordinate. Otherwise, the values are in the PIXEL space. The x and y coordinates can be extracted from either the Bounding Box Top Left Hand Corner (0070,0010) or Anchor Point (0070,0014). AIM TwoDimensionSpatialCoordinate Graphic Annotation Module Attributes Required Appropriate Integer value used to identify, name, or Yes 0 characterize the nature, properties, or contents of a thing. coordinateindex 0 Yes 0 imagereferenceuid Referenced SOP Instance UID (0008,1155) Yes referencedframenumber Referenced Frame Number (0008,1160) Yes 0, 1, etc x Bounding Box Annotation Units (0070,0003) Yes or Anchor Point (0070,0014). The row offset of the pixel from TLHC. y Bounding Box Annotation Units (0070,0003) Yes or Anchor Point (0070,0014). The column offset of the pixel from TLHC. Table 3.1.1.7-3. AIM TwoDimensionSpatialCoordinate

3.1.1.8. Converting GSPS Graphical Annotation to AIM MultiPoint, Point, Circle, Ellipse, Polyline and TwoDimensionSpatialCoordinate DICOM GSPS Graphical Annotation module (C.10.5, DICOM 2009) may contain textual descriptions and graphical drawings. The information can be captured in the AIM model. This section explains how to extract graphical drawings from the GSPS Graphical Annotation module and store the information in AIM classes. The graphic type stored in AIM model can be of type MultiPoint, Point, Circle, Ellipse and Polyline. DICOM 2009 graphic type is mapped to AIM graphic type as shown in Table 3.1.1.8-1. AIM Graphic Type DICOM 2009 Graphic Type POINT POINT POLYLINE POLYLINE MULTIPOINT INTERPOLATED CIRCLE CIRCLE ELLIPSE ELLIPSE Table 3.1.1.8-1. Graphic Type Mapping DICOM Presentation State objects may contain one or more graphic types. If all graphic types are referenced to the same anatomical location, there will be only one AIM instance required. However, if graphical drawings do not share the same region of interest, there must be multiple AIM instances created for each region of interest. For example, an abdomen CT image has two graphical drawings. First, a polyline (closed polygon) covers a liver area. Second, a line measures a region on a kidney. Since the two graphical drawings were done on different parts of the anatomy, there must be two AIM instances created for each graphical drawing. Graphic information shall be extracted if the information exists in the Graphical Annotation module. It is stored in MultiPoint, Point, Circle, Ellipse or Polyline class. These classes mark a region of interest. Graphic data contains one or more points corresponding to a class. These points are stored in TwoDimensionSpatialCoordinate. Therefore, every graphic type must have one or more instances of type TwoDimensionSpatialCoordinate. AIM MultiPoint Graphic Annotation Module Attributes Required Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. linecolor. Enter empty No lineopacity. Enter empty No linestyle. Enter empty No linethickness. Enter empty No includeflag Value is always true. Yes shapeidentifier A unique Integer number within a collection of text and graphical Yes markups Table 3.1.1.8-2. AIM MultiPoint AIM Point Graphic Annotation Module Attributes Required Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. linecolor. Enter empty No lineopacity. Enter empty No linestyle. Enter empty No linethickness. Enter empty No includeflag Value is always true. Yes shapeidentifier A unique Integer number within a collection of text and graphical Yes markups Table 3.1.1.8-3. AIM Point

AIM Circle Graphic Annotation Module Attributes Required Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. linecolor. Enter empty No lineopacity. Enter empty No linestyle. Enter empty No linethickness. Enter empty No includeflag A Boolean flag that indicates if the shape is to be included (true) or Yes excluded (false) from the annotation. Intended to allow specific components of a lesion to be excluded such as in a donut. shapeidentifier A unique Integer number within a collection of text and graphical Yes markups Table 3.1.1.8-4. AIM Circle AIM Ellipse Graphic Annotation Module Attributes Required Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. linecolor. Enter empty No lineopacity. Enter empty No linestyle. Enter empty No linethickness. Enter empty No includeflag A Boolean flag that indicates if the shape is to be included (true) or Yes excluded (false) from the annotation. Intended to allow specific components of a lesion to be excluded such as in a donut. shapeidentifier A unique Integer number within a collection of text and graphical Yes markups Table 3.1.1.8-5. AIM Ellipse AIM Polyline Graphic Annotation Module Attributes Required Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. linecolor. Enter empty No lineopacity. Enter empty No linestyle. Enter empty No linethickness. Enter empty No includeflag A Boolean flag that indicates if the shape is to be included (true) or Yes excluded (false) from the annotation. Intended to allow specific components of a lesion to be excluded such as in a donut. shapeidentifier A unique Integer number within a collection of text and graphical Yes markups Table 3.1.1.8-6. AIM Polyline Note: In order to set the includeflag attribute properly for Circle, Ellipse and Polyline (closed polygon) instances, there shall be two types of these graphical drawings, one inside another. The enclosed graphical drawing includeflag value shall be set to false if the shape is to be excluded such as in a donut shape. The other graphical drawing, includeflag, shall be set to true. The current TwoDimensionSpatialCoordinate does not have an explicit support for enumerated value PIXEL or DISPLAY, defined in DICOM standard, to indicate how a given coordinate shall be used. The x and y coordinate contain a value of type double. If extracted values are between 0.0 and 1.0 for x and y, they are in DISPLAY coordinate. Otherwise, the values are in PIXEL space. A set of x and y coordinates can be extracted from Graphic Data (0070,0022). Table 3.1.1.8-7 displays how extracted values are mapped to AIM attributes. AIM Graphic Annotation Module Attributes Required

TwoDimensionSpatialCoordinate Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. coordinateindex The order in which a coordinate appears. Yes imagereferenceuid Referenced SOP Instance UID (0008,1155) Yes referencedframenumber Referenced Frame Number (0008,1160) Yes x Graphic Data (0070,0022) Yes y Graphic Data (0070,0022) Yes Table 3.1.1.8-7. AIM TwoDimensionSpatialCoordinate 3.1.2. Converting CSPS to AIM 3.0 The same approach from section 3.1.1.1 to 3.1.1.8 can be used to convert DICOM CSPS to AIM model. 3.1.3. Converting PCSPS to AIM 3.0 The same approach from section 3.1.1.1 to 3.1.1.8 can be used to convert DICOM PCSPS to AIM model.

4. Gap Analysis between DICOM Presentation State and AIM 4.1. Mapping Between DICOM Presentation State and AIM The AIM information model can store other types of information that have semantic meaning associated with medical images, such as anatomical location, imaging observation related to anatomic entity, and calculation results that may or may not be related directly to graphical drawings. Section 3 describes how to extract information from the DICOM Presentation State and store in the AIM model. However, it does not discuss what additional information may be entered to the AIM model. Table 4.1-1 illustrates information mapping between the two models. AIM classes that match Not applicable do not have information that can be extracted from the DICOM Presentation State object. AIM Class Name AimStatus AnatomicEntity AnatomicEntityCharacteristic Annotation AnnotationOfAnnotation AnnotationRole Calculation CalculationData CalculationResult CharacteristicQuantification Circle Coordinate DICOMImageReference Dimension Ellipse Equipment GeometricShape Image ImageAnnotation ImageReference ImageSeries ImageStudy ImagingObservation ImagingObservationCharacteristic Inference Interval MultiPoint NonQuantifiable Numerical Person Point Polyline PresentationState Quantile ReferencedAnnotation ReferencedCalculation ReferencedGeometricShape Scale Segmentation DICOM GSPS IOD MODULES but must be generated Presentation State Relationship (C.11.11) but must be generated General Series (C.7.3.1) General Study (C.7.2.1) Patient (C.7.1.1) SOP Common Module (C.12.1)

SpatialCoordinate TextAnnotation ThreeDimensionSpatialCoordinate TwoDimensionSpatialCoordinate User WebImageReference Table 4.1-1. AIM Information Model and GSPS Capabilities There are some AIM classes that can be completed with valuable information provided by developers of a DICOM Presentation State to AIM conversion program. 4.1.1. AIM User The AIM User class collects information about the creator of an AIM instance. The creator can be a human or a machine. In this case, we use a program to convert DICOM Presentation State to an AIM instance. The program is the creator. AIM User Information Required Required Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. name The name of the conversion program. (recommended) Yes loginname The name of the conversion program. (recommended) Yes roleintrial. Enter empty No numberwithinroleofclinicaltrial. Enter empty No Table 4.1.1-1. AIM User 4.1.2. AIM Equipment The Equipment class stores information about the equipment used to create an AIM instance. The software that is used to create AIM instances shall have its information store in this class. AIM Equipment Information Required Required Integer value used to identify, name, or characterize the nature, Yes properties, or contents of a thing. manufacturername The name of the organization created the converter program. Yes manufacturermodelname The name of the software. No softwareversion The version number of the converter program. No Table 4.1.2-1. AIM Equipment 4.2. AIM Image Semantic Content The AIM information model has a collection of classes that store explanatory or descriptive information and findings of images using coded terminology. These classes are Anatomic Entity and its characteristic, Characteristic Quantification for the Anatomic Entity s characteristic, Imaging Observation and its characteristic, Characteristic Quantification for the Imaging Observation s characteristic, and Inference. An inference is a conclusion derived by observing an imaging study and/or medical history. This type of information cannot be found in the DICOM Presentation State object. For example, a computer-aided detection program that can identify an anatomic entity and its characteristic may be used to automatically create values from AnatomicEntity and AnatomicEntityCharacteristic. This type of an approach is not covered in this document. It is mentioned here as a possible solution for adding more information to an AIM instance.

Appendix A References No Artifact Type Link 1 09_03pu2.pdf PDF file 2 02_03_AIM_Project_Rep ort.doc 3 AIM_v3_rv11_XMI_XM L_Schemas.zip Microsoft Word XMI file ftp://medical.nema.org/medical/dicom/2009/09_03pu3.doc https://gforge.nci.nih.gov/frs/download.php/9112/aim_v3.0.1_rv11.rar https://gforge.nci.nih.gov/frs/download.php/8990/aim_v3_rv11_xmi_x ML_Schemas.zip Appendix B Glossary Term AIM API caaers CSPS CT DICOM GSPS GUI IOD PCSPS SOP SR TLHC XML Definition Annotation and Image Markup Application Programming Interface Cancer Adverse Events Reporting System Color Softcopy Presentation State Computed Tomography Digital Imaging and Communications in Medicine Grayscale Softcopy Presentation State Graphical User Interface Information Object Definition Pseudo-Color Softcopy Presentation State Sevice-Object-Pair Structured Report Top Left Hand Corner extended Markup Language

Term UID UML VOI LUT Definition Unique Identifier Unified Modeling Language Volume of Interest Look Up Table